Patient perspectives on smoking and peripheral vascular disease. A veteran population survey

In keeping with the recent emphasis on smoking and health, we conducted a survey of patients with peripheral vascular disease in our institution. The objective of the survey was to examine the patient's perspective on a) the relative contribution of smoking to his disease, b) the value of alternative measures to encourage smoking cessation, and c) the smoker's role and responsibility in payment for future health care. One hundred sixty patients at the VAMC in Palo Alto, California, participated in the study. The participants were men who had visited the clinic with complaints related to vascular insufficiency. The "typical" smoker from our survey a) had smoked for more than 30 years, b) acknowledges the association between smoking and disease, and c) will not stop smoking until serious health problems intervene. The majority of respondents expected the same health care regardless of smoking history and did not endorse paying more for health services. Most patients identified serious heart and lung disease as potential sequelae of cigarette smoking, however only 44 per cent of active smokers attributed their peripheral vascular disease to smoking. Although the survey was conducted on patients with complaints related to vascular insufficiency, few respondents identified an association in smoking with gangrene of the lower extremity or leg amputations. It is unclear whether this represents a failure on the part of health professionals to stress this relationship or denial on the part of the smoker. Physicians should continue to advise against cigarette smoking. A strong relationship between continued smoking and lower extremity ischemia or amputation needs to be emphasized in the clinical setting and through public health information campaigns.